Diclazuril/Emetine Hydrochloride 833 Diminazene Aceturate (BANM, rINNM) Skin irritation, such as erythema or a stinging or burn- African trypanosomiasis. Eflornithine is effective in the Aceturato de diminazeno; Diminazène, Acéturate de; Diminaze- ing sensation, has been reported after topical applica- treatment of Trypanosoma brucei gambiense infections (p.827), and is particularly valuable in providing an alternative to melar- ni Aceturas. 1,3-Bis(4-amidinophenyl)triazene bis(N-acetylglycin- tion of eflornithine. soprol in meningoencephalitic disease.1-3 Eflornithine ate). Effects on the ears. A study in 58 patients1 receiving eflorni- 100 mg/kg intravenously every 6 hours for 7 days, rather than the Диминазена Ацетурат thine alone or with interferon alfa for the treatment of metastatic standard 14 days, produced long-term responses in 42 of 47 pa- 4 C22H29N9O6 = 515.5. melanoma found that hearing loss was related to the cumulative tients who had relapsed after other treatment regimens. Similar CAS — 536-71-0 (diminazene); 908-54-3 (diminazene dose of eflornithine and was worse in patients with pre-existing positive results in relapsing cases were obtained with a short 7- aceturate). hearing deficit. day course in a multicentre randomised controlled study,5 al- 1. Croghan MK, et al. Dose-related α-difluoromethylornithine oto- though this short course was inferior to the 14-day course for toxicity. Am J Clin Oncol 1991; 14: 331–5. new cases, in whom it could not be recommended. A patient who NH NH had relapsed after treatment with melarsoprol and eflornithine Effects on the heart. Fatal cardiac arrest occurred in an AIDS given singly was cured when the drugs were given together.6 Ef- patient with pneumocystis pneumonia during the intravenous in- lornithine is not effective when given alone in T. b. rhodesiense H2N NH2 fusion of eflornithine 100 mg/kg over 1 hour.1 Sudden death af- infections, and early reports of its use with suramin were not en- N ter infusion of eflornithine had occurred in several other critically couraging.7 However, benefit has been reported from use with ill patients with AIDS. N N nifurtimox.8 H 1. Barbarash RA, et al. Alpha-difluoromethylornithine infusion 1. Chappuis F, et al. Eflornithine is safer than melarsoprol for the and cardiac arrest. Ann Intern Med 1986; 105: 141–2. (diminazene) treatment of second-stage Trypanosoma brucei gambiense hu- man African trypanosomiasis. Clin Infect Dis 2005; 41: 748–51. Pharmacokinetics 2. Balasegaram M, et al. Melarsoprol versus eflornithine for treat- NOTE. Diminazene aceturate is often referred to by its veterinary Eflornithine hydrochloride is absorbed from the gas- ing late-stage Gambian trypanosomiasis in the Republic of the proprietary name Berenil. Congo. Bull WHO 2006; 84: 783–91. trointestinal tract. After intravenous doses about 80% 3. Priotto G, et al. Safety and effectiveness of first line eflornithine Profile is excreted unchanged in the urine in 24 hours. The ter- for Trypanosoma brucei gambiense sleeping sickness in Sudan: Diminazene aceturate, an aromatic diamidine derivative related cohort study. BMJ 2008; 336: 705–8. to pentamidine, is an antiprotozoal that has been used in veteri- minal elimination half-life is about 3 hours. It is distrib- 4. Khonde N, et al. A seven days course of eflornithine for relaps- uted to the CSF. ing Trypanosoma brucei gambiense sleeping sickness. Trans R nary practice in the treatment of trypanosomiasis and babesiosis. Soc Trop Med Hyg 1997; 91: 212–13. It has also been tried in human infections. Less than 1% of a dose is absorbed after topical appli- 5. Pepin J, et al. Short-course eflornithine in Gambian trypano- somiasis: a multicentre randomized controlled trial. Bull WHO cation. 2000; 78: 1284–95. ◊ References. 6. Simarro PP, Asumu PN. Gambian trypanosomiasis and syner- Dinitolmide (BAN, rINN) gism between melarsoprol and eflornithine: first case report. 1. Haegele KD, et al. Kinetics of α-difluoromethylornithine: an ir- Trans R Soc Trop Med Hyg 1996; 90: 315. Dinitolmida; Dinitolmidum; Dinitrotoluamide; Methyldinitrobenz- reversible inhibitor of ornithine decarboxylase. Clin Pharmacol 7. Clerinx J, et al. Treatment of late stage rhodesiense trypano- amide. 3,5-Dinitro-o-toluamide. Ther 1981; 30: 210–17. somiasis using suramin and eflornithine: report of six cases. 2. Milord F, et al. Eflornithine concentrations in serum and cere- Динитолмид Trans R Soc Trop Med Hyg 1998; 92: 449–50. brospinal fluid of 63 patients treated for Trypanosoma brucei 8. Priotto G, et al. Nifurtimox-eflornithine combination therapy for C8H7N3O5 = 225.2. gambiense sleeping sickness. Trans R Soc Trop Med Hyg 1993; second-stage Trypanosoma brucei gambiense sleeping sickness: CAS — 148-01-6. 87: 473–7. a randomized clinical trial in Congo. Clin Infect Dis 2007; 45: ATC Vet — QP51AX12. 3. Malhotra B, et al. Percutaneous absorption and pharmacokinet- 1435–42. ics of eflornithine HCl 13.9% cream in women with unwanted facial hair. J Clin Pharmacol 2001; 41: 972–8. Preparations Proprietary Preparations (details are given in Part 3) O NH2 Uses and Administration Austral.: Vaniqa; Cz.: Vaniqa; Fr.: Vaniqa; Ger.: Vaniqa; Irl.: Vaniqa; Ital.: Eflornithine is an antiprotozoal that acts as an irrevers- Vaniqa; Neth.: Vaniqa; Port.: Vaniqa; Spain: Vaniqa; UK: Vaniqa; USA: CH Ornidyl; Vaniqa. 3 ible inhibitor of ornithine decarboxylase, the rate-lim- iting enzyme in polyamine biosynthesis; trypanosomes are more susceptible to the effects of eflornithine than Emetine Hydrochloride (BANM) O2N NO2 are humans, probably because of their slower turnover Cloridrato de Emetina; Emet. Hydrochlor.; Emetiinihydrokloridi; Pharmacopoeias. In BP(Vet). of this enzyme. Emetina, hidrocloruro de; Emetin-dihydrochlorid; Émétine, chlo- BP(Vet) 2008 (Dinitolmide). A cream to light tan powder. Prac- Eflornithine is used in African trypanosomiasis due to rhydrate d’; Emetine Dihydrochloride; Emetin-hidroklorid; Emet- tically insoluble in water; slightly soluble in alcohol, in chloro- Trypanosoma brucei gambiense. It is effective in the inhydroklorid; Emetini Chloridum; Emetini Dihydrochloridum; form, and in ether; soluble in acetone. Emetini hydrochloridum; Emetino hidrochloridas; Emetyny early and, more importantly, in the late stage of the dis- Profile dichlorowodorek; Ipecine Hydrochloride; Methylcephaëline Hy- Dinitolmide is an antiprotozoal used in veterinary practice for the ease (when there is CNS involvement). drochloride. 6′,7′,10,11-Tetramethoxyemetan dihydrochloride prevention of coccidiosis in poultry. In the treatment of African trypanosomiasis, eflorni- heptahydrate; (2S,3R,11bS)-3-Ethyl-1,3,4,6,7,11b-hexahydro- thine hydrochloride is given by intravenous infusion. 9,10-dimethoxy-2-[(1R)-1,2,3,4-tetrahydro-6,7-dimethoxy-1- The dose is 100 mg/kg every 6 hours for at least 14 isoquinolylmethyl]-2H-benzo[a]quinolizine dihydrochloride hep- days. Each dose should be given over a period of at tahydrate. Eflornithine Hydrochloride least 45 minutes. Dosage should be reduced in patients Эметина Гидрохлорид (BANM, USAN, rINNM) C29H40N2O4,2HCl,7H2O = 679.7. with renal impairment. CAS — 483-18-1 (emetine); 316-42-7 (anhydrous emet- DFMO; α-Difluoromethylornithine Hydrochloride; Éflornithine, Eflornithine hydrochloride is also applied topically ine hydrochloride); 7083-71-8 (emetine hydrochloride, hy- Chlorhydrate d’; Eflornithini Hydrochloridum; Hidrocloruro de drate); 79300-08-6 (emetine hydrochloride, heptahy- twice daily for the reduction of unwanted facial hair in drate). eflornitina; MDL-71782; MDL-71782A; RMI-71782. 2-(Difluor- women. It is available as a cream containing 15% ef- omethyl)-DL-ornithine monohydrochloride monohydrate. ATC — P01AX02. lornithine hydrochloride monohydrate; in the UK this Эфлорнитина Гидрохлорид content is expressed as 11.5% eflornithine and in the C6H12F2N2O2,HCl,H2O = 236.6. H3CO CAS — 67037-37-0 (eflornithine); 96020-91-6 (eflorni- USA as 13.9% anhydrous eflornithine hydrochloride. thine hydrochloride). Cryptosporidiosis. Eflornithine has been tried in the treatment 1 N ATC — D11AX16; P01CX03. of cryptosporidiosis (p.823) in AIDS patients. H3CO ATC Vet — QD11AX16. 1. Rolston KVI, et al. Intestinal cryptosporidiosis treated with ef- H lornithine: a prospective study among patients with AIDS. J Ac- CH3 quir Immune Defic Syndr 1989; 2: 426–30. H F Hirsutism. Topical eflornithine hydrochloride applied twice H2N daily as a 13.9% cream is effective in reducing the growth of OCH3 unwanted facial hair in females (see Hirsutism, p.2089), al- HN H2N F though it must be used indefinitely to prevent regrowth.1 Its ac- tion is thought to be due to the irreversible inhibition of ornithine COOH OCH decarboxylase in hair follicles. It has also been used successfully 3 2 (eflornithine) in combination with laser hair removal. (emetine) 1. Barman Balfour JA, McClellan K. Topical eflornithine. Am J Clin Dermatol 2001; 2: 197–201. In Chin., Eur. (see p.vii), and Viet. 2. Hamzavi I, et al. A randomized bilateral vehicle-controlled Pharmacopoeias. Adverse Effects and Precautions study of eflornithine cream combined with laser treatment versus Eur. also has a monograph for Emetine Hydrochloride Pentahy- Myelosuppression may lead to anaemia, leucopenia, laser treatment alone for facial hirsutism in women. J Am Acad drate; Int. permits the heptahydrate or pentahydrate in the same Dermatol 2007; 57: 54–9. monograph. US has a monograph for the anhydrous salt. and thrombocytopenia. Some patients have had hear- Ph. Eur. 6.2 (Emetine Hydrochloride Heptahydrate;